Grassroots Challenges to the Effects of Prison Sprawl on Mental Health Services for Incarcerated People

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TABLE OF CONTENTS Introduction 438 I. Deinstitutionalization and Resulting Deficiencies in New York's Prison Mental Health Care System 449 A. An Abridged History of the Deinstitutionalization Movement 449 B. The Scope of the System and the Availability of Mental Health Treatment in New York State Prisons 454 1. Regional Catchment Areas 461 2. VTC in New York Prisons: Implementation, Current Practices, and Shortcomings 463 II. The Insufficiency of Litigation Solutions Absent Grassroots Approaches 472 A. An Abridged Overview of the Eighth Amendment Framework 473 1. Defendant Failed to Conduct an Adequate Examination, Take an Adequate History, or Ask Necessary Questions 476 2. Defendant Failed to Remedy Known Systemic Deficiencies, such as an Institutional Lack of Access to Qualified Staff or Repeated Failures to Afford Proper Placement 479 B. A Grassroots Approach is Necessary to Correct the Systemic Problems Litigation Usually Cannot Address 486 III. A Grassroots Solution to the Geographic Crisis Causing Subpar Prison Mental Health Treatment 487 Conclusion 497

INTRODUCTION

During the mid-1950s, amidst burgeoning awareness among social justice activists of the abuse and neglect of individuals with mental health needs in psychiatric hospitals, the number of individuals confined to those hospitals peaked. (1) Five hundred and sixty thousand patients were held in often brutal conditions, and scores of them were denied access to basic necessities of life, such as the right to form and maintain interpersonal relationships. (2) Rather than simply accept such severe restrictions upon their humanity, people who were confined to institutions told their stories. (3) Due chiefly to their courage and the courage of their families and friends, a robust psychiatric deinstitutionalization movement emerged. (4) That movement--at its peak during the 1960s and 1970s--forced psychiatric professionals, state governments, and the federal government to reckon with a treatment model that systematically devalued the lives of thousands of people. (5) Although many states shuttered large psychiatric institutions in response to that movement, a large number of them--including New York--failed to devote necessary resources to the development of robust, community-based alternatives that could provide psychiatric care. (6) Because the creation of a community-based care model, the chief goal of the deinstitutionalization movement, was not actualized, some scholars consider the movement a failure. (7) Furthermore, many of those in need who stood to benefit from the movement wound up poor, destitute, or homeless as a result--arguably not much better off than they were before. (8)

The "law and order" movement, which grew alongside the deinstitutionalization movement, led to the increasingly draconian criminalization of conduct often related to, or directly attributable to, mental health needs. (9) Driven largely by establishment politicians increasingly buoyed by "tough on crime" rhetoric, the "law and order" movement produced significant regressive legal reforms. (10) One such example are New York's Rockefeller Drug Laws, enacted in 1973, which mandated harsher penalties for both the sale and possession of small amounts of banned narcotics. (11) The Rockefeller Drug Laws and other state and federal laws enacted during the "law and order" movement criminalized conduct often attributable to a manifestation of mental health needs. (12) For example, increased criminalization of substance abuse disproportionately impacts individuals with mental health needs, as over fifty percent of people with mental health needs have a co-occurring and related substance use disorder. …